BCR Analyzation; < Age 60

Davinci RP in 9/21 margins were clear but there was Perineural invasion, and Lymphovascular invasion although a right lymph node was taken and was negative. Tumor Stage pT2c, pNO. High fives all around (celebration not a new lab test...)

then psa's of
01/26/22 0.039
04/26/22 0.091

Although I'm a bit older, my surgeon consider me a BCR at .091 trending upward PSA wise. His view is to take an aggressive tack. Although I'm ok with aggressive treatment in general, knowing what I know now, I'd have waited for at least one more test to confirm the trend. I started salvage radiation and orgovyx pretty much when I hit that mark. The feeling on his part seemed to be that it was inevitable.

I'm about 1.75 years post SRT still on orgovyx and testing at < .006 consistently at this point (knocks wood).

The problem with early PSMA tests is that they tend to be negative in the lower psa ranges. I had one that was negative at around .091. Another poster here shared this chart with us from one of the research sites.

Best of luck to you!

Many similar aspects; treated as BCR.

RP at Johns Hopkins Aug 2022 - surgical margins, seminal vesicles and lymph nodes clear.
Extraprostatic Extension (EPE) found by Pathology and confirmed Gleason 9.
pT3aN0
1st PSA 90 days postop .19
Referred immediately to Radiation Oncology.
PSMA PET not definitive.
Salvage radiation together with 4 mos ADT completed June 2023.
Whole pelvic region (WPRT) together with pelvic lymph nodes treated.
See SPPORT trial
1st post tx PSA < .02 in Nov.
Coincidentally, 2d uPSA test 2 days ago and anxiously waiting for results today or Friday.
My research similar to yours; .2 - .4/.5 BCR and sweet spot for treatment.
Believe trend is to treat earlier. Absent specific positive PSMA PET scan findings, belief is that residual cancer cells in pelvic floor and/or pelvic lymph nodes.
Best wishes.

Try googling PCF.org January 17, 2023 webinar titled When PSA starts rising. There's a transcript of the entire webinar which includes an Oncologist and Surgeon opinion about when and how to treat a rising PSA number.

Thanks for your story. Much appreciated. Knowledge is power for us all. Please advise how old were you at time of radiation, and why you wish you would have waited for 1 more PSA to confirm the trend. Keeping all in prayers.

Thanks for your story. I definitely understand the anxiety. PSAitis is what my Urologist refers to it as. Mine keeps telling me that I will suffer effects of radiation because I am young, and its better to wait for PSA to get higher to try and pinpoint via a PSMA test. Naturally, Im thinking if wait to long (say past .4/5) then % chance of metastasis may go up. Also wondering if hormone therapy would actually decrease chance of pinpointing at a later date via PSMA test. Obviously, very subjective decision. Keeping all in prayers.

Thank you for the info.

My urologist was most annoyed at me for delaying the salvage radiation as my PSA slowly began to increase post RP. He referred me to a radiation oncologist when my PSA reached .052. Since I was willing to pay for a private PSMA-PET scan the RO was willing to wait for my PSA to increase to .300 in order to increase the odds that the scan might detect the location of the cancer. Fortunately the scan did detect a small cancerous cell where my seminal vesicle had been. I believe you should be referred to a RO. I was also told by the team performing the Salvage Radiation that studies had shown that two injections of ADT (Zoladex in my case) improved the likelihood of the Salvation Radiation being successful. Fortunately, 19 months later my PSA is still undetectable < .008. However, it continues to be a waiting game.

Thank you for sharing your information.

I was 60 at the time of the SRT.
I just felt that it's possible, albeit remotely, that the .091 indication may have been an anomaly. Waiting another 3 mos for another test to confirm the trend wouldn't have been likely to change any outcomes.

Thank you sir